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Antenatal prevention of cerebral palsy and childhood disability: is the impossible possible?
Author(s) -
Ellery Stacey J.,
Kelleher Meredith,
Grigsby Peta,
Burd Irina,
Derks Jan B.,
Hirst Jon,
Miller Suzanne L.,
Sherman Larry S.,
Tolcos Mary,
Walker David W.
Publication year - 2018
Publication title -
the journal of physiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.802
H-Index - 240
eISSN - 1469-7793
pISSN - 0022-3751
DOI - 10.1113/jp275595
Subject(s) - cerebral palsy , hypoxia (environmental) , medicine , brain damage , microglia , pregnancy , inflammation , intrauterine growth restriction , fetus , neuroscience , pediatrics , physical medicine and rehabilitation , psychology , biology , chemistry , organic chemistry , oxygen , genetics
This review covers our current knowledge of the causes of perinatal brain injury leading to cerebral palsy‐like outcomes, and argues that much of this brain damage is preventable. We review the experimental evidence that there are treatments that can be safely administered to women in late pregnancy that decrease the likelihood and extent of perinatal brain damage that occurs because of acute and severe hypoxia that arises during some births, and the additional impact of chronic fetal hypoxia, infection, inflammation, growth restriction and preterm birth. We discuss the types of interventions required to ameliorate or even prevent apoptotic and necrotic cell death, and the vulnerability of all the major cell types in the brain (neurons, astrocytes, oligodendrocytes, microglia, cerebral vasculature) to hypoxia/ischaemia, and whether a pan‐protective treatment given to the mother before birth is a realistic prospect.